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Rheumatic Heart Disease

Immunopathogenesis, Prophylaxis and Therapy

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Summary

Rheumatic heart disease remains a major problem in developing countries, as it occurs early in life and in severe form. Apart from the well-recognised aetiological factors of poverty and overcrowding, increased virulence of the infecting streptococci and antigenic crossreactivity between streptococcal M protein and cardiac tissue have also been implicated.

The following factors all point to a strong likelihood of genetic susceptibility in affected individuals: (a) an association with human leucocyte (HLA) antigens at the D locus; (b) an association with particular alloantigens on B lymphocytes; (c) heightened responsiveness of T cells to stimulation with streptococcal polysaccharide; and (d) increased avidity for adherence of rheumatogenic streptococci to mucosal cells in the pharynx. Altered cell-mediated immunity also appears to be implicated.

Penicillin prophylaxis is the mainstay of prevention. To overcome problems such as noncompliance, a national computer register of all patients with the disease is desirable in countries whose health budgets would allow this, together with intensive continuing health education of both health workers and the general public and the issuing of patient-carried identification cards to those receiving continuous prophylaxis.

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  1. Department of Paediatrics, Faculty of Medicine, University of Natal, Durban, P.O. Box 17039, Congella, 4013, South Africa

    Ismail E. Haffejee

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Haffejee, I.E. Rheumatic Heart Disease. Clin Immunother 4, 72–82 (1995). https://doi.org/10.1007/BF03259072

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